VACCINOLOGY IN ACTION
“Astra Forum” Foundation presented the February edition of the vaccine school called “Vaccinology in action”. The hosts provided each and every medical specialist with the opportunity to watch the event live, as well as online. In the present edition, “Astra Forum” partners with Patient’s portal and the WHO office in Bulgaria, and the hall in Launchee in the Central Department Store was overflowing. The Foundation invited the lecturers, chief assistant Ivelina Trifonova, PhD Evgeni Penchev, professor Neli Korsun and PhD Ralitsa Yordanova, professor PhD Mira Kozhuharova and PhD Trifon Valkov, professor PhD Radka Argirova and PhD Rositsa Chipeva. The event moderator was the master of pharmacy Mariela Marcheva, and the special guests in the opening panel were Jennifer Melgaard from the WHO office in Bulgaria and the director of the National Centre of Infectious and Parasitic Diseases, professor Iva Hristova.
All the lecturers clarified not only the general information about various infectious diseases, but shared the newest innovations in prevention and elaboration of vaccines against these. The diseases that were the focal points of the present edition of Vaccine school, were influenza and acute respiratory diseases (ARD), Respiratory syncytial virus (RSV), measles and human papilloma virus (HPV).
In his welcoming speech, the chairman of the “Astra Forum” Foundation, Momchil Baev, doctor of medicine, talked about the widespread interest caused by the event “Vaccine school” that is held for the first time live as well as online. The initiative was born in 2022, and one of its main objectives is to facilitate communication between doctors and patients about immunization and enrich doctors’ knowledge regularly. Namely because of this, the hosts created Manual for all the medical specialists interested in vaccine prophylactics – “Interpersonal communication about immunization”. Inside it one could find a wide range of information provided by UNICEF and the WHO. Soon we would publish the second renewed edition of the manual that would be available for free online as well as on paper. Meanwhile those who are willing to do so, could review the first collection edition here.
The first panel of the event gave the floor to chief assistant Ivelina Trifonova and doctor Evgeni Penchev. The young specialists presented data about flu viruses, their dissemination in Bulgaria, laboratory diagnostics and vaccinal prophylactics. It is worth noting that we observe an increase of dissemination and versatility of flu viruses in recent years as well as the fact that most patients that tested positive are aged up to 16. Among the most frequent complications after going through the disease are pneumonia, laryngitis, bronchiolitis and impact on central nervous system. Vaccine success is proven by the low number of complications observed in elderly patients. The information about flu viruses is renewed every year thanks to countries all around the world, which provide their discoveries and researches. In the last flu season in Bulgaria, general practitioners administered over 310 000 vaccines. Consequently, doctor Penchev presented the methods of diagnostics and the various symptoms observed in the cases of flu diseases. The cases of clinical practice always bring about interest among the audience at similar events and impart additional “colour” to scientific theory. In doctor Penchev’s opinion, it is of key importance for the diagnostics to be performed as soon as possible that is supported by methods such as PCR and antigen tests. The same is in effect about therapy (symptomatic or specific) that should start as early as possible. When it comes to vaccines, they are highly recommended for people aged over 65, as well as for numerous risk groups such as pregnant women, children, medical personnel or personnel that works in homes for elderly, persons with chronic diseases, as well as the ones that work in swine rearing and bird raising. Another key element is prophylactics – pre-exposure or post-exposure.
The next topic was about virus infection RSV, its consequences and its prophylactics. This is the most frequent infection cause of the upper and lower respiratory tract of children. Professor Neli Korsun and doctor Ralitsa Yordanova presented the data about RSV and prophylactics. It is well-known that one could catch RSV more than once (infection severity depends on one’s immunity), whereas once again the most vulnerable are breastfed babies, pregnant women, elderly people. Doctor Yordanova presented the clinical significance of the infection while declaring this is one of the leasing reasons for hospitalization in early childhood age and development of bronchiolitis, pneumonia, acute respiratory insufficiency or ARDS. This could happen with patients of other risk groups as well. In the case of breastfed babies we could observe acute bronchiolitis, central cyanosis, tachypnoea, apnoeic pauses, frequent co-infections with bacterial causes. Usually, the symptoms of RSV include cold, dry cough, febrility, pneumonia and the immunocompromised patients could experience dyspnoea, pleural effusions or face fatal end. Immunoprophylactic could be even prenatal when the child is about to be born during the first RSV season. In addition to the traditional methods for infection prevention, there are already different preparations for pre-exposure prophylactics, as well as recently licensed vaccines for adults, for example Abrysvo. Despite the rare side effects after it administration, the vaccine is efficient, mostly in newborns. Other recommended vaccines for the various age groups are Nirsevimab, RSVpreF, RSVpreF3, Palivizumab.
As an end of the conference, doctor Radka Argirova and doctor Rositsa Chipeva reviewed the dissemination, clinical picture and methods for HPV virus prevention. Professor Argirova presented the golden standards in diagnosing the virus. HPV is a group of over 100 viruses, whereas 14 of them cause almost all cases of cervical cancer. Professor Argirova noted that Bulgaria is among the three countries in the European Union that do not have national screening program against this infection. She highlighted the fact that the HPV-DNA screening has much higher sensitivity than the PAP cytology in identifying the infection – with the obsolete PAP methodology there is significant probability of missing numerous disease cases, hence it is essential to introduce the DNA-HPV method in Bulgaria. Of course, this necessitates collaboration between society, medical professionals and institutions. It is recommendable to start the vaccination against the virus at 10. Of course, the vaccine suggests continuous control and prophylactics. It is important to add that vaccination is the most effective in healthy patients, whereas screening is a way to evaluate the risk of catching the disease. The examinations of healthy patients should be performed every 5 years. In Bulgaria, we are about to prepare national screening program with the assistance of the ministry of health and laboratories.
The presentation of doctor Chipeva demonstrated numerous manifestations and symptoms of the human papilloma virus in clinical practice. They may have cutaneous and genital, as well as oncogenic impact. The risk groups include persons with numerous sexual partners, smokers, women with genital warts, urogenital infections, HIV. Men could also catch the virus. In their case, circumcision significantly decreases the risk. The men at risk are the ones with injuries or rashes along the penis, ureteral stricture and others. The non-genital skin lesions could be in the pattern of ordinary, plantar, flat, mosaic warts, Butcher warts, nail flat carcinoma. Oncological manifestations of HPV could be seen in the pattern of Epidermodysplasia verruciformis, non-verrucous skin lesions, respiratory papillomatosis, lung squamous carcinoma, laryngeal papilloma of the maxillary sinus etc. Among the non-genital skin lesions it is worth mentioning the conjunctival carcinoma, oral carcinoma, oral leucoplakia etc.
The HPV virus causes 99.7% of the cervical cancer cases (CC). In Bulgaria, cervical cancer, mammary gland cancer, lung cancer and colorectal carcinoma are among the 5 most frequent types of cancer among women. Cervical cancer is a global challenge whereas in practice every woman on the planet faces the threat of this disease. The risk increases in the cases of smoking, life with HIV or another immunosuppressive condition, three and more births, use of contraceptives for more than 5 years. The cervical caner nevertheless is highly preventable thanks to the vaccine against human papilloma virus. The WHO objectives on the topic are until 2030 the number of vaccinated girls aged up to 18 to reach 90%, 70% of women aged between 35 and 45 to be monitored and tested and 90% of the identified women to undergo treatment. Nevertheless, without significant intervention, the expectations are that until 2030 morbidity rate would go up to 700 000 cases and the death cases would grow with 17%.
Watch more in our video on YouTube – Ваксинология в действие.
